Healthcare Provider Details

I. General information

NPI: 1598118408
Provider Name (Legal Business Name): EZEQUIEL DAVID MUNOZ GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 N MERIDIAN ST
CARMEL IN
46290-1028
US

IV. Provider business mailing address

10590 N MERIDIAN ST
CARMEL IN
46290-1028
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125069265
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01087464A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01087464A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01087464A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: